Cutoff Point For Patients Research Articles

Subcutaneous infliximab cut-off points in patients with inflammatory bowel disease. Data from the ENEIDA registry.

Switching from the intravenous to the subcutaneous biosimilar infliximab (SC-IFX) has been shown to safely maintain clinical remission and increase drug levels in patients with Crohn's disease (CD) and ulcerative colitis (UC). The aim of this study was to evaluate long-term outcomes after switching from intravenous IFX (IV-IFX) to SC-IFX, the drug concentration thresholds for maintaining remission and other predictors for loss of response after the switch. Multicenter observational study involving CD and UC patients who were in clinical remission for at least 24 weeks and scheduled to switch from IV-IFX to SC-IFX. Two hundred and twenty patients were included [74 UC (34%) and 146 (66%) CD]. IV-IFX was administered for 52.5 months [range 25-89]. Pre-switch, 106 (49%) patients were receiving intensified IV-IFX. While SC-IFX levels significantly increased following the switch from IV to SC-IFX, clinical parameters, C-reactive protein and faecal calprotectin remained unchanged during follow-up. SC-IFX levels were significantly higher between patients receiving the standard IV-IFX dose than those with the intensified dose. Immunomodulator therapy at baseline and perianal disease had no effect on IFX trough levels, whereas higher body mass index was associated with increased levels. The suggested optimal SC-IFX cut-off concentration for clinical and biochemical remission based on ROC analysis was 12.2 μg/mL (AUC: 0.62) at week 12 and 13.2 μg/mL (AUC: 0.57) at week 52. Drug persistence was 92% at week 52, with a good safety profile. Switching from IV-IFX to SC-IFX safely maintains long-term remission in patients with CD and UC. In maintenance, the optimal cut-off point associated with remission was 12-13 μg/mL.

Effectiveness over time of the reverse shoulder prosthesis for acute proximal humeral fracture

Reverse shoulder arthroplasty (RSA) has proven to be an effective surgical procedure for irreparable rotator cuff tears, comminuted fractures of the proximal humerus and shoulder arthroplasty revision surgeries. We know from the literature that the functional results are good in the short term, but not whether these results remain stable in the long term or, on the contrary, show a deterioration in functionality. This study aims to analyze the functionality, degree of satisfaction, complications, and prosthesis survival at different cut-off points in patients with complex proximal humerus fractures treated with RSA, with a minimum postoperative follow-up of 7 years. Analytical, longitudinal and prospective observational study of a cohort of patients treated for a fracture of the proximal humerus with PIH. Functional outcome was assessed using the Constant scale and the Constant adjusted for age and gender of the patients. Quality of life was measured using the University of California at Los Angeles Shoulder Assessment scale (UCLA) and the Disability of the Arm, Shoulder and Hand score scale (QuickDASH). In addition, range of motion, pain and radiological variables of loosening, scapular notching and tuberosity consolidation were assessed. Thirty-three patients were included with a mean postoperative follow-up of 8.3 years (range 7-12 years). There was a progressive and significant decrease in Constant score at 5and7years follow-up compared to the baseline assessment 2 years after surgery, although the effect size was not significant. The age- and sex-adjusted Constant as well as the UCLA scale did not show statistically significant variations at follow-up. Both shoulder abduction and anterior shoulder flexion correlated well with the final QuickDASH score. Radiological variables did not influence any of the study outcome variables. The functionality and quality of life of patients with complex proximal humerus fractures treated with RSA decreased significantly compared to the 2-year evaluation, although this change was not clinically relevant. Survival of RSA was satisfactory in the medium to long term with a low complication rate.

Mid-arm muscle circumference cutoff points in patients with cirrhosis: Low muscle mass related to malnutrition predicts mortality

ObjectivesMuscle loss is one of the phenotypic criteria of malnutrition, is highly prevalent in patients with cirrhosis, and is associated with adverse outcomes. Mid-arm muscle circumference (MAMC) estimates the skeletal muscle mass and is especially helpful in cases of fluid overload. This study aimed to propose MAMC cutoff points for patients with cirrhosis and demonstrate its association with 1-year mortality. MethodsThis is an analysis of cohort databases from five reference centers in Brazil that included inpatients and outpatients with cirrhosis aged ≥18 y. The nutritional variables obtained were the MAMC (n = 1075) and the subjective global assessment (n = 629). We established the MAMC cutoff points stratified by sex based on the subjective global assessment as a reference standard for malnutrition diagnosis, considering the sensitivity, specificity, and Youden index. An adjusted Cox regression model was used to test the association of MAMC cutoff points and 1-year mortality. ResultsWe included 1075 patients with cirrhosis, with a mean age of 54.8 ± 11.3 y; 70.4% (n = 757) male. Most patients had alcoholic cirrhosis (47.1%, n = 506) and were classified as Child-Pugh B (44.7%, n = 480). The MAMC cutoff points for moderate and severe depletion were ≤21.5 cm and ≤24.2 cm; ≤20.9 cm and ≤22.9 cm for women and men, respectively. According to these cutoff points, 13.8% (n = 148) and 35.1% (n = 377) of the patients had moderate or severe MAMC depletion, respectively. The 1-year mortality rate was 17.3% (n = 186). In the multivariate analysis adjusted for sex, age, MELD-Na, and Child-Pugh scores, a severe depletion in MAMC was an independent increased risk factor for 1-year mortality (HR: 1.71, 95% CI: 1.24–2.35, P < 0.001). Each increase of 1 cm in MAMC values was associated with an 11% reduction in 1-year mortality risk (HR: 0.89, 95% CI: 0.85–0.94, P < 0.001). ConclusionsLow MAMC classified according to the new cutoff points predicts mortality risk in patients with cirrhosis and could be used in clinical practice.

Determination of Shock Index and Age Shock Index Cut-Off Points in Patients with ST-Segment Elevation Myocardial Infarction: SEMI-CI Study

Determination of Shock Index and Age Shock Index Cut-Off Points in Patients with ST-Segment Elevation Myocardial Infarction: SEMI-CI Study

Evaluation of Cutoff Point Prostate Specific Antigen (PSA) and Prostate Specific Antigen Density (PSAD) in Patients with Suspected Prostate Cancer.

Prostate cancer is the second leading cause of cancer death in men worldwide. There is no national standard for PSA cut-off levels even through the transrectal prostate biopsy procedure causes many serious complications such as bleeding, infection, and sepsis. Therefore, determining cut-off levels for PSA and PSAD is essential to avoid unnecessary biopsies. This study aims to determine the Prostate Specific Antigen (PSA) and Prostate Specific Antigen Density (PSAD) cut-off points in patients with suspected prostate cancer. A retrospective study was conducted from January 2018 until March 2021 in Saiful Anwar General Hospital Malang Indonesia. Inclusion criterias were patients with suspected prostate cancer; > 50 years old; underwent PSA, PSAD, and prostate biopsy. Exclusion criterias were patients refuse to participate in the study and incomplete patient medical record data. Medical records from 53 patients who underwent transrectal ultrasonography (TRUS)-guided prostate biopsy were reviewed. Statistical analysis was performed using Mann-Whitney U, Chi-Square, Fisher's Exact, and Receiver Operator Characteristic (ROC) curves. Medical records conducted 53 patients who met inclusion criteria and underwent transrectal ultrasonography (TRUS)-guided prostate biopsy were reviewed. PSA cut off level for prostate biopsy was 19.71 ng/ml with a sensitivity of 69.23% and a specificity of 72.5%. The positive predictive value is 45% and the negative predictive value is 87.87%. PSAD cut off level for prostate biopsy was 0.4113 with a sensitivity of 61.54% and a specificity of 63.16%. The positive predictive value is 36.36% and the negative predictive value is 82.76%. Results from this study, the cut off levels of PSA and PSAD in prostate disease patients is higher than the recommended cut off; prostate cancer is the largest malignancy in men worldwide and has a higher incidence in the older age and high serum PSA levels group.

In the Diagnosis of Liver Fibrosis Developing in Nonalcoholic Fatty Liver Patients; Could Serum Fetuin A Be a Candidate Biomarker

Previous studies have reported in the literature that fetuin A, released from the liver, may be a useful serum biomarker in the diagnosis of nonalcoholic fatty liver disease (NAFLD). However, results are not consistent in predicting nonalcoholic steatohepatitis (NASH) and fibrosis, which are indicative of progressive NAFLD patients. The aim of this study was to investigate the importance of serum fetuin A in detecting NASH and fibrosis, which are determinants of morbidity, in patients with liver biopsy-proven NAFLD. This observational case-control study included 40 NAFLD patients diagnosed by liver biopsy and 25 healthy volunteer controls. The demographic characteristics of the patients and healthy volunteers were recorded, biochemical tests were done, and the serum fetuin A levels of the participants were determined by the enzyme-linked immunosorbent assay method. Serum fetuin A levels were significantly higher in both the nonalcoholic fatty liver (NAFL) (608.30 μg/mL; p&lt;0.001) and NAFLD (536.58 μg/mL; p=0.008) groups compared to the control group (345.07 μg/mL). However, no significant difference was detected in the NASH group (417.06 μg/mL; p=0.740). When patients with and without fibrosis were compared, the mean serum fetuin A levels of patients with fibrosis were significantly lower (708 μg/mL and 380 μg/mL, respectively; p&lt;0.001). When receiver operating characteristic (ROC) analysis was performed, the best cut-off point for patients with fibrosis was 510.98 μg/mL with 94.7% sensitivity and 66.7% specificity (p&lt;0.001). Serum fetuin A may be a useful biomarker in the diagnosis of NAFLD patients and in predicting liver fibrosis.

Definition of activity cut-off point in patients with Behçet’s disease using the Arabic version of the Behcet’s Syndrome Activity Scale.

Definition of activity cut-off point in patients with Behçet’s disease using the Arabic version of the Behcet’s Syndrome Activity Scale.

Risk stratification of women with gestational diabetes mellitus using mutually exclusive categories based on the International Association of Diabetes and Pregnancy Study Groups criteria for the development of postpartum dysglycaemia: a retrospective cohort study

ObjectivesWomen with gestational diabetes mellitus (GDM) are more predisposed to develop postpartum diabetes mellitus (DM). This study aimed to estimate the relative risk (RR) of postpartum dysglycaemia (prediabetes and DM)...

Cardiac computed tomography tissue tracking of the right ventricle longitudinal strain in patients with pulmonary thromboembolism

Abstract Background Pulmonary embolism (PE) represents a common entity with a broad clinical spectrum. Right ventricle (RV) dysfunction remains the leading cause of mortality. Current guidelines recommend a multimodal stratification, including echocardiographic or computed tomography and high-sensitive cardiac troponin (hs-cTn) for stratification of the risk. It is of utmost importance to identify those patients at highest risk for clinical deterioration. Longitudinal Strain (LS) is a new generation technique that quantifies the myocardial deformation without geometric assumptions, allowing the assessment of the RV myocardial function. Purpose Firstly, we aim to detect early RV abnormalities in patients with acute PE, with the LS value. Secondly, evaluate if there is a significant difference between Right Ventricle Longitudinal Strain (RVLS) in patients with acute PE versus controls without any cardiac pathology. Methods Observational retrospective single-centre study from patients 18 years or older admitted to the ER with proved PE by multiphase CT angiogram from 2016 to 2020. We included a control group from non-cardiac chest pain causes with multiphase CT angiogram negative for PE, without evidence of valvular disease and a coronary calcium score of 0. We evaluated the RV in the four-chamber views to obtain the LS value using tissue tracking CT software. A ROC curve assessed the LS performance for RV dysfunction detection. We calculated the Youden index for every value to identify the best cut-point. We considered a P value of &amp;lt;0.05 for statistical significance with a confidence interval of 95%. Results From a total of 53 patients with PE diagnostic only 10 fulfilled all the inclusion criteria. For the control group there were 500 patients with CT angiogram of which only 33 had a complete multiphase sequence. 63% of the patients included in the PE group were considered of high-risk PE with expression of hs-cTn, the rest were classified as intermediate risk. Average hs-cTn in the high-risk group was 149.3 ng/dL, which correlated with a lower RVLS in comparison to the intermediate risk PE without being statistically significative. Brain Natriuretic Peptide (BNP) had a higher correlation between lower RVLS in patients with intermediate and high-risk PE, respectively (80.56 pg/mL vs 466.02 pg/ml). There is an overt tendency for alteration of the RVLS in patients with PE compared to the control group (−8.41% vs. −21.09%; P&amp;lt;0.001). The AUC for the cut-point of −18.25% for the LS was 0.89 (CI 95%, 0.70–1.00), with a sensibility of 90.9% and specificity of 90% for RV dysfunction. Conclusion There is no reference value of RVLS in the general population. We propose the cut-point value of −18.25% for LS by cardiac CT to detect early RV dysfunction in patients with PE. Based on our findings we proposed a LS value of −21.09% cut-off point for patients with no cardiac disease. The correlation and clinical impact as prognostic factors, is yet to be studied. Funding Acknowledgement Type of funding sources: None.

Prognostic utility of pretreatment neutrophil-lymphocyte ratio in survival outcomes in localized non-small cell lung cancer patients treated with stereotactic body radiotherapy: Selection of an ideal clinical cutoff point

Background and purposeNeutrophil-lymphocyte ratio (NLR) has been associated with overall survival (OS) in non-small cell lung cancer (NSCLC). We aimed to assess the utility of NLR as a predictor of lung cancer-specific survival (LCS) and identify an optimal, pretreatment cutoff point in patients with localized NSCLC treated with stereotactic body radiotherapy (SBRT) within the Veterans Affairs’ (VA) national database. Materials and methodsIn the VA database, we identified patients with biopsy-proven, clinical stage I NSCLC treated with SBRT between 2006 and 2015. Cutoff points for NLR were calculated using Contal/O’Quigley’s and Cox Wald methods. Primary outcomes of OS, LCS, and non-lung cancer survival (NCS) were evaluated in Cox and Fine-Gray models. ResultsIn 389 patients, optimal NLR cutoff was identified as 4.0. In multivariable models, NLR > 4.0 was associated with decreased OS (HR 1.44, p = 0.01) and NCS (HR 1.68, p = 0.01) but not with LCS (HR 1.32, p = 0.09). In a subset analysis of 229 patients with pulmonary function tests, NLR > 4.0 remained associated with worse OS (HR 1.51, p = 0.02) and NCS (HR 2.18, p = 0.01) while the association with LCS decreased further (HR 1.22, p = 0.39). ConclusionNLR was associated with worse OS in patients with localized NSCLC treated with SBRT; however, NLR was only associated with NCS and not with LCS. Pretreatment NLR, with a cutoff of 4.0, offers potential as a marker of competing mortality risk which can aid in risk stratification in this typically frail and comorbid population. Further studies are needed to validate pretreatment NLR as a clinical tool in this setting.

Clinical performance of ASAS Health Index in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis: real-world evidence from Multicenter Nationwide Registry.

The Assessment of SpondyloArthritis international Society Health Index (ASAS HI) is used as a new instrument in measuring the function, disability and health of patients with spondyloarthritis (SpA). However, the real-world evidence of ASAS HI is very limited. In the present study, our objective is to evaluate the psychometric properties and performance of ASAS HI in the real-world setting as well as comparing ASAS HI with the current instruments to assess the construct validity and determine the cut-off points in patients with both ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). A total of 991 patients with axSpA who fulfilled either the ASAS classification criteria for axial SpA (axSpA) or the Modified New York Criteria (mNY) for AS were recruited from the Biologic and targeted Synthetic antirheumatic drugs Registry (BioStaR) SpA. The construct validity of ASAS HI against the Bath Ankylosing Spondylitis Disease Activities Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP) the Bath Ankylosing Spondylitis Functional index (BASFI) was performed. Using the receiver operating characteristic (ROC) curves analysis, the cut-off points were calculated. Of all the recruited patients, 851 (85.9%) were AS and 140 (14.1%) were nr-axSpA. The difference in the mean ASAS HI scores of the patients with AS and the ones with nr-axSpA were not statistically significant (6.12 ± 4.29 and 6.42 ± 4.86, respectively). The mean ASAS HI score was significantly higher in females and small city residents. The ASAS HI had a strong construct validity against ASDAS-CRP, BASDAI and BASFI. A cut-off point of ≤ 4 was determined to discriminate good and moderate, as well as ≥ 12 to discriminate moderate and poor health status. In conclusion, ASAS HI is a reliable instrument to evaluate health and functioning for both patients with AS and nr-axSpA in clinical practice.

Age, prostate volume, prostate-specific antigen and prostate-specific antigen density as predictor factors in results of transrectal ultrasonography-guided prostate biopsy

Background: To identify the predictor factors, such as prostate-specific antigen (PSA), age, prostate volume (PV), and PSA density (PSAD) as indications to perform transrectal ultrasonography (TRUS)-guided prostate biopsy in reducing unnecessary biopsies and improving detection rate. Methods: A total of 1232 samples were obtained from the medical records of patients underwent prostate biopsy from January 2008 to December 2013 in Cipto Mangunkusumo Hospital Jakarta. Pre-biopsy data including age, PSA, prostate volume, and PSAD were obtained. The Mann-Whitney U-test and unpaired t-test were conducted on the quantitative variables; a chi-square test was used for qualitative variables. This study also conducted receiver operating characteristic (ROC) curve analysis to determine the cut-off point and the optimum specificity and sensitivity for each variable. Results: Among 1232 patients, 33.5% had a positive biopsy result. The median age and PSA (68 years and 57.45 ng/ml) in the positive biopsy group was higher than in the negative group (65 years and 11.69 ng/ml), p &lt;0.001. PSAD in patients with PSA 4-10 ng/ml, 10-20 ng/ml, and 20 ng/ml (0.20, 0.35, 2.05) in positive group was higher than negative group (0.14, 0.24, 0.53), p &lt;0.001. Those with a positive biopsy result had a lower median PV (42 ml (range, 13.8-208)) compared to those with negative biopsies (55.4 ml) (p &lt;0.001). In ROC curve, PSAD had the highest sensitivity and specificity (81.4% and 82.0%) with a cut-off point of 0.43 ng/ml/ml (p &lt;0.001). Conclusion: The incidence of PCa increased with higher PSA level, older age and lower PV. Utilization of PSAD 0.17 ng/ml/ml as a cut-off point in patients with PSA level between 4-10 ng/ml is recommended to improve PCa detection in Indonesian men.

CUT-OFF POINT OF PSA AND PSA DENSITY IN PROSTATE CANCER SUSPECTED PATIENTS

Objective: In Hasan Sadikin General Hospital Bandung prostate biopsy is recommended for patients with prostate specific antigen (PSA) levels above 10 ng/mL or PSA density (PSAD) above 0.15 if PSA in between 4–10 ng/mL. However, there were other factors beside of prostate cancer (PCa) that could influence PSA value, such as racial differences and prostatitis. Thus, the optimal cut-off point for PSA is still debatable in national level. This research aimed to determine PSA and PSAD cut-off point for patient suspected of PCa in Hasan Sadikin Hospital Bandung. Material &amp; Methods: A total of 502 patients underwent prostate biopsy for suspicion PCa from 2010–2014. The cut-off point of PSA and PSAD is generated from receiver operating characteristic (ROC) curve. Results: The cut-off point for PSA was 14.6 ng/mL (sensitivity 81.4%, specificity 29.8%). The cut-off point for PSAD was 0.23 (sensitivity 81.4%, specificity 34.8%). Positive predictive value (PPV) for this new cut-off point of PSA and PSAD were 41.1% and 37.6% respectively. Conclusion: PSA and PSAD cut-off point for patients in our center was 14.6 ng/mL and 0.23 respectively. This value is relatively higher compared to the Indonesian consensus. The difference might occur due to high rate of urinary tract infection in patients attending Hasan Sadikin General Hospital Bandung.

Potential utility of a renal function adjusted D-dimer cut-off value for improving the exclusion of pulmonary embolism

To evaluate the potential utility of a renal function adjusted D-dimer cut-off value for improving the exclusion of pulmonary embolism. Retrospective analyses were performed for 1 784 inpatients and outpatients with low and moderate probability of pulmonary embolism at Anzhen Hospital from January 2011 to June 2013. The Well's score was used. The diagnoses of pulmonary embolism were confirmed by computed tomography pulmonary angiogram and ventilation-perfusion scan. Based upon estimated glomerular filtration rate (GFR), they were divided into three subgroups of normal renal function, mild renal impairment and moderate renal impairment. Negative D-dimer was defined as a level of age-standardized D-dimer value<500 µg/L. The proportions of patients with negative D-dimer and the utility of D-dimer for ruling out pulmonary embolism were compared between three subgroups. A new D-dimer cut-off point in patients with renal impairment was developed by receiver operating characteristics (ROC) curves and the effect of diagnostic efficiency of ruling out pulmonary embolism with renal function adjusted D-dimer cut-off was assessed. The medians of D-dimer of three subgroups with normal renal function, mild renal impairment and moderate renal impairment were 291.5, 995.5 and 1 901.5 µg/L (P<0.001) respectively. The sensitivity of negative D-dimer for ruling out pulmonary embolism was 99%-100% and the specificity 70%, 42% and 23% in three subgroups. The number of patients needed to test (NNT) for one negative test of D-dimer in three subgroups of different renal function was 3.32, 3.58 and 3.95 respectively. The new D-dimer cut-off value increased to 1.2 and 1.75 times of old one in patients with mild and moderate renal impairments and the proportion of patients with a negative D-dimer level rose from 48.7% to 53.0% as compared with old D-dimer cut-off value. The sensitivity and specificity of negative D-dimer for ruling out pulmonary embolism was 98% and 62% with the new cut-off value versus 99% and 57% with the old cut-off value and the NNT of D-dimer for ruling out pulmonary embolism declined from 3.52 to 3.34. The renal function adjusted D-dimer cut-off point can improve the diagnostic efficiency of D-dimer test for ruling out pulmonary embolism.

The value of signal peptide-CUB-EGF domain-containing protein-1 (SCUBE1) in the diagnosis of pulmonary embolism: a preliminary study.

The diagnosis of pulmonary embolism (PE) in the emergency department still poses difficulties because symptoms and signs are nonspecific. There is a need for more reliable noninvasive diagnostic tests to support clinical suspicion before the costly invasive procedures with complication risks still used in the diagnosis of PE. Signal peptide-CUB (complement C1r/C1s, Uegf, and Bmp1)-EGF (epidermal growth factor) domain-containing protein 1 (SCUBE1) is a novel, secreted cell surface protein expressed during early embryogenesis. The goal of this study was to compare the SCUBE1 levels between PE patients and healthy subjects and also investigate the value of SCUBE1 in the diagnosis of PE. Eleven patients diagnosed with PE using spiral computerized tomographic pulmonary angiography were included in the study. A control group of 23 age-matched, healthy volunteers served as a reference for biochemical parameters. Mean (±SD) SCUBE1 levels were 72.0 (±32.6) ng/mL in the patients with PE and 31.4 (±13.8) ng/mL in the control group. SCUBE1 levels were significantly higher in the patients with PE (p = 0.001). Receiver operating characteristic (ROC) curve analysis was performed to determine cutoff thresholds in discriminating between PE and control group plasma SCUBE1 levels. Area under the ROC for that purpose was 0.862 (95% confidence interval [CI] = 0.70 to 1). A SCUBE1 cutoff point in patients with PE > 46 ng/mL had specificity and sensitivity of 91% (95% CI = 0.70% to 0.98%) and 82% (95% CI = 0.48% to 0.97%), respectively. This preliminary study suggests that plasma SCUBE1 values have a good level of specificity for PE and may be of use in the diagnosis of PE. Further studies involving larger case series and also clinical studies are needed to corroborate these findings.

Improvement of olfactory function for quality of life recovery

To explore quality of life (QoL) improvement after treatment of patients with chronic olfactory disorders; and to correlate QoL with olfactory rehabilitation and evaluate olfactory improvement values over which QoL outcomes are significantly recovered. Prospective clinical study. Eighty-nine patients following endoscopic sinus surgery for chronic rhinosinusitis (CRS) and immunotherapy for allergic rhinitis (AR) were studied. Olfactory function was evaluated using Sniffin' Sticks test pre-and 12 months after treatment. All patients completed six validated QoL questionnaires either specific for olfaction (Questionnaire of Olfactory Deficits-QOD) and for assessing mental health (Zung Anxiety Scale, State-Trait Anxiety Inventory, Zung Depression Scale, Beck Depression Inventory), or generic one (Short Form-36). Significant improvement (all P < 0.001) of olfactory function by 27.4% in total cohort (AR: 10.4%, P = 0.004; CRS: 39.9%, P < 0.001), expressed by the combined Threshold-Discrimination-Identification (TDI) score-and of all QoL questionnaires scores (all P < 0.01) as well, was observed after treatment. There was a positive correlation between olfactory recovery and improvement of patients' QoL. ROC analysis revealed that an increase in the TDI score by 3.50 points in AR and 4.75 points in CRS was necessary for a clinically significant improvement in all QoL questionnaires results. QoL and mental health of patients suffering from chronic sinonasal diseases are totally recovered after treatment, presenting a direct positive relationship with smell improvement. An increase of olfactory function by 3.50 points for AR and 4.75 points for CRS might be considered the cutoff point for patients' QoL significant recovery.

Proposal of a New Classification for Stage III Colorectal Cancer Based on the Number and Ratio of Metastatic Lymph Nodes

The objective of this retrospective study was to determine whether the current staging system for stage III colorectal cancer (CRC) is appropriate and to assess the value of the metastatic lymph node ratio (LNR) in predicting the prognosis of patients with stage III CRC. From 2000 to 2006 inclusively, 245 patients with stage III CRC underwent curative resection. The follow-up was closed in March 2012. Kaplan-Meier survival curves and log-rank tests were used for the survival analysis. Survival time of patients with T3N1M0 was significantly better than that for patients in other subgroups of stage IIIB and similar to that of patients with stage IIIA disease. The greatest survival difference was found with 0.30 as the LNR cutoff point for patients with current stage III CRC. Survival time of patients with LNR ≤ 0.30 was significantly better than that of those with LNR > 0.30. rN1 included stage III patients with LNR ≤ 0.30, and rN2 included patients with LNR > 0.30. Survival time of patients with T4aN1(rN2)M0 staging was significantly worse than that for patients with T4aN1(rN1)M0 staging and similar to that of patients with stage IIIC CRC. We propose an algorithm to incorporate LNR into the current American Joint Committee on Cancer staging system. In it the patients with T3N1M0 are excluded from the current stage IIIB and included in the stage IIIA group. Also, patients with T4aN1(rN2)M0 are excluded from the current stage IIIB group and included in the stage IIIC group.

Association between chronic hepatitis C virus infection and high levels of circulating N-terminal pro-brain natriuretic peptide

The association between HCV infection and myocardial disorders remains unclear. This study aimed to assess whether or not HCV infection influences myocardial dysfunction by the use of NT-proBNP, a sensitive marker of myocardial dysfunction. A total of 198 participants [99 patients with chronic HCV infection (aged 46-68 years) and 99 anti-HCV-negative sex and age matched controls] were examined. Serum HCV-RNA level and HCV genotype were tested and liver biopsy was done only for the patient group. The NT-proBNP concentration of the HCV patients (mean 71.6 ± 79.1 pg/ml; median 46.0 pg/ml, range 5.0-400.0) was significantly higher than that of the controls (mean 39.8 ± 24.4 pg/ml; median 35.8 pg/ml, range 7.0-108.0) (P < 0.05). 20.0 % of the HCV patients and 0.6 % of the controls had high NT-proBNP (higher than 125 pg/ml; the single cut off point for patients under 75 years of age) (P < 0.05). Stepwise multiple regression analysis revealed that chronic HCV infection was independently correlated with NT-proBNP level after adjustment for parameters that might influence NT-proBNP (P = 0.005). Our data suggest that chronic HCV infection is associated with increased NT-proBNP, indicating that chronic HCV infection might induce myocardial dysfunction.

Validity of the NIHSS in predicting arterial occlusion in cerebral infarction is time-dependent

The NIH Stroke Scale (NIHSS) is used to assess acute ischemic stroke severity and outcome. High NIHSS scores are usually associated with arterial occlusion but it is unknown what the effect of time to clinical evaluation (TTCE) in this association is. We tested the NIHSS scores as an instrument to determine vessel occlusion (VO) at different time points from symptom onset. Patients were selected from our prospective stroke database if they had admission NIHSS scores and intracranial vessel neuroimaging studies. We dichotomized patients according to VO and TTCE. Receiver operating curves, c statistics, and odds ratios were calculated to study the validity of the NIHSS score. Among 463 patients (mean age 70.2 years, 53.1% male, median NIHSS 4, median TTCE 3.3 hours), 22.5% had arterial occlusion. Median NIHSS scores were higher in patients with VO, 10.5 (interquartile range 5-18) vs 3 (2-7), p<0.001, and in those with TTCE<6 hours, 15 (interquartile range 7-19) vs 4 (2-8) if ≥6 hours, p<0.001. Receiver operating characteristic curves showed that the validity of NIHSS in predicting VO was higher in patients with TTCE<6 hours, p=0.03. The best cutoff point in patients evaluated before 6 hours was an NIHSS of 7 (76.2% sensitivity, specificity 70.1%), while in patients evaluated after 6 hours the best cutoff point was 4 (sensitivity 65.4%, specificity 62.0%). Our study shows that the validity of NIHSS scores in predicting arterial occlusion is time-dependent, decreasing with increasing time from symptom onset to clinical evaluation.

Tumor Volume Assessment by18F-FDG PET/CT in Patients with Oral Cavity Cancer with Dental Artifacts on CT or MR Images

The purpose of this study was to investigate the clinical usefulness of PET/CT or CT-attenuated PET in the evaluation of patients with oral cavity cancer (OCC) in whom dental artifacts distorted the conventional CT or MR images of the oral cavity. A PET/CT scan, in addition to a CT or MRI scan, was performed in 69 patients with OCC who had dentures or dental implants. A total of 64 PET/CT, 64 CT, and 27 MR images were analyzed including images from scans performed on 40 patients with OCC without dental artifacts on the conventional images; these were used for comparison. The CT-attenuated PET scan for the detection of primary tumors was compared with the CT or MRI scan. We also evaluated the correlation between the PET/CT volume and the pathologic volume using a regression analysis. In addition, subgroup analysis was performed to determine what proportion of subjects benefited most from the PET/CT. CT-attenuated PET detected more primary tumors than did CT in patients with OCC with dental artifacts (95.3% vs. 75.0%, respectively; P=0.0016). PET/CT volume with a standardized uptake value (SUV) cutoff point of 3.5 predicted the pathologic volume more accurately than did the other cutoff points in patients with OCC with or without artifacts. After comparing pathologic volume and PET/CT(SUV 3.5) volume, the following regression equation was developed: log (pathologic volume)=0.6 x log (PET/CT(SUV 3.5) volume) + 1.3 (R(2) = 0.42, P<0.0001). Subgroup analysis showed that the prediction of the pathologic volume from the PET/CT images was more reliable for tumors that were more than 2 cm in depth (R(2)=0.72). For patients with OCC with dental artifacts on the conventional imaging, PET/CT could provide useful clinical information about the primary tumors, particularly in cases with advanced tumors.